Provider Demographics
NPI:1578559654
Name:STAR MEDICAL EQUIPMENT, INC
Entity Type:Organization
Organization Name:STAR MEDICAL EQUIPMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:WOOLAM
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:806-762-6777
Mailing Address - Street 1:11912 SLIDE RD
Mailing Address - Street 2:
Mailing Address - City:LUBBOCK
Mailing Address - State:TX
Mailing Address - Zip Code:79424-7445
Mailing Address - Country:US
Mailing Address - Phone:806-762-6777
Mailing Address - Fax:806-762-6780
Practice Address - Street 1:11912 SLIDE RD
Practice Address - Street 2:
Practice Address - City:LUBBOCK
Practice Address - State:TX
Practice Address - Zip Code:79424-7445
Practice Address - Country:US
Practice Address - Phone:806-762-6777
Practice Address - Fax:806-762-6780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-23
Last Update Date:2009-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0044528332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX017202501Medicaid
TX017202501Medicaid